About 15 years ago I worked with this nice girl named Katy, and several weeks into our working relationship she one day asked if I wanted to hang out. I was immediately nervous that she was looking for a date. “Oh, uh. I’m gay,” I said, sheepishly.
“I know” she said with a smile. “I just want to be friends.”
I was thrilled, since I didn’t have many friends, even fewer female friends, and she seemed pretty amazing, with her purple-colored hair and no-fools-suffered attitude, and was a really good 3D artist as well. We met at a sushi place and began getting to know each other. Eventually the conversation turned to dating, and I related my long, complicated history with men, then soon realized I had been talking about myself for too long. “What was your last date?” I asked.
“It’s complicated,” she said.
“I have time,” I said in jest.
“Well,” she reluctantly continued, “dating is really hard when you’re trans.”
“Trans?” I asked. “Who is trans?”
“I am,” she replied. I was totally confused. “You’re trans? As in, transgender?”
She nodded. I was still confused. “As in, you used to be male?" I said clumsily. Again she nodded. While I had been familiar with some famous transgender actors and activists I had never yet knowingly met someone who was actually trans, and here I was on a friend date with someone who was. “Wow,” I said. “I had absolutely no idea. That’s so cool.”
She smiled and said, “Thanks, sometimes I think I feel really obvious.” I shook my head and laughed. “No, absolutely not.”
Over the last three decades my attention has largely been preoccupied by my own struggles with depression and metabolic illness, and I haven’t energetically engaged in many other causes orbiting our collective struggle as a society and family. But I have been aware of the deep and painful problems facing those who are transgender, and while I have not lived this experience I have some insight on hormones, health, and acceptance gleaned from my own struggles with wellness that would be valuable to those who are transgender, especially when it comes to hormones and mental health.
Passing as a particular gender is in no way an estimate of your value as a person or your own life experience, and anyone who is transgender doesn’t need me to say there will be uncomfortable experiences with naive, ignorant, well-intentioned or even prejudiced and hateful people that will cause you sadness, stress, and sometimes feeling alone. Once even I, a staunch advocate of the entire LGBTQI+ community, accidentally misgendered someone while at dinner with lots of friends (and then greatly appreciated their kindness and patience correcting me). All humans are given to callous, indifferent, obtuse, or even harsh behavior, so don’t let it deter you from being who you are and seeking your own happiness, whatever that may be. As humans we are also given to naturally pay more attention to unpleasant and negative experiences which can in turn prejudice our own experience to one which seems infected with more sadness than there really is. This is a natural protective mechanism we have for our own survival because nice people and experiences are not a threat to our survival, so we must be more aware of those which are. But if ten people are in a room and one of them treats us poorly this means we tend to feel like the majority of the world is against us, even though nine of those didn’t act that way, and considering that other humans are more often just as timid, uncertain, and afraid just as we are, even if those other nine didn’t stand up for us does not mean they didn’t feel the same revulsion and fear at the behavior of a smarmy, hateful person. I used to feel so alone because so few of my friends and relatives failed to stand up for my rights and wellbeing as a gay man, but in writing both of my books and working with many hundreds of people I have come to learn that most fail to do this because they are struggling with their own issues of depression, trauma, and survival, and not because they don’t care. Keeping this in mind as we progress along our journey can help take some of the sting out of it. Do not fill that silence with assumptions of negativity. It will only increase stress and is in all likelihood not an accurate assessment of the world, even if it does sometimes seem overwhelming and depressing. I know from my own experience that there are far more loving and caring people in the world than may be obvious, because they are also by nature not loud or obnoxious and it can be difficult to see them, sometimes even requiring that we actively look.
Being transgender has nothing to do with the process of transitioning, though many ignorant people misunderstand this since they simply hear the prefix “trans” and associate different words without further inquiry, and a transgender person is transgender whether or not they receive gender affirming medical care, and indeed those who are transgender are born as such just as the rest of us who are gay or cis or heterosexual are also born that way too. It’s the great irony any time conservative bigots whine about “biological sex” or “science” as if they actually know anything about biology or science and are not simply acting the bigot, that being transgender is as much biological as any other condition of humanity, and if you don’t understand the biology behind gender and sexuality you can read my other article Why Transgender Women are Women and Transgender Men are Men.
Fundamentally, there are two big problems faced by those who are born transgender. The first is that the outward, apparent gender of the body is mismatched from that of the brain and mind. Many people want to identify sex by another person’s observable features like the genitals, but someone’s sex has nothing to do with other people and is instead a personal experience that has nothing to fucking do with you, and the greater determinant of sex and gender than the exterior sex organs is the brain which is every bit a part of our biology as the genitals which controls the genitals and without which the genitals would not even function. This disparity between the inner and outer sex identity can and does cause stress to the transgender individual (often termed gender dysphoria), especially since the world often interacts with them based on their outward appearance when in fact their inner identity is the real one. The second problem is that the society we are born into is greatly infected with hate, bigotry, prejudice, and fear of the Other, and environmental stresses which cause or contribute to depression, isolation, anxiety, PTSD, and loneliness compounds the stress of the transgender individual already experiencing a great amount of hate, rejection, and fear from others who should just leave them alone. First I will briefly discuss depression as it is faced by those who are transgender, and later I will talk about hormones and effective transition strategies.
Depression in all humans has long been misunderstood, most of all by the medical profession, and while there are some helpful medications that can be used to restrain serious mental health problems they are largely based on the idea that the hormone serotonin is that which is responsible for our happiness or depression. This in turn is based on flawed studies which showed that regulating serotonin produced somewhat desirable effects in restraining the manic/depressive behavior in some subjects, producing more subdued and restrained responses. This actually occurs because serotonin is a hormone of torpor, which means to slow things down, and so it produces an effect of lethargy upon the person who is subjected to the kinds of medications which regulate serotonin which is in turn mistaken as therapeutic to the condition of depression. This is why so many pharmaceutical products which focus on depression also come with ironic side effects as increased risk of suicide, which on the face of it should be enough for anyone to be suspicious of their efficacy. As discussed in my book, F*ck Portion Control in the chapter on depression, depression is instead a deficiency of dopamine which results from excessive stresses to our mental and physical wellbeing which deplete dopamine through an excess of adrenaline which is in turn made from dopamine. Many people will recognize the greatest adrenaline stimulants in our existence is actually other humans, but dieting, excessive exercise, and deficiency of sun exposure also raise adrenaline, and the primary route by which depression originates is the constant fight-or-flight reflex engaged when growing up a vulnerable minority, for instance those who are transgender who live in constant fear of their safety, because the chronic and high expression of adrenaline then chronically depletes dopamine. Depression can be directly dealt with through accessible nutritional and environmental changes to support the dopamine pathways and restrain excessive adrenaline production as discussed in F*ck Portion Control (the eBook is donation based so there is no pay barrier to anyone).
While the act of transitioning is not what makes a person transgender, part of the cause of depression for transgender people is not having a body which aligns with their gender identity, and achieving one which does can bring great relief for those who are transgender. Anyone who is not transgender but has difficulty understanding this can consider your own gender then imagine having the complete opposite body and genitalia than what you currently have, and that feeling which occurs is what transgender people experience every day of their lives before they receive gender affirming medical care (this is also a good time to point out that those who aren’t transgender also frequently receive gender affirming care such as from hormone replacement therapy, cosmetic care or procedures, even hair dye). But when it comes to hormones the medical community is also greatly mistaken as to the effect and role of certain important hormones which cause gender characteristics. The truth is that no hormones have gender, and gender instead arises out of the ratios and amounts of particular hormones to each other. For instance, women have testosterone and androgens, which are typically considered male hormones, and just as in men the hormone testosterone promotes sexual arousal and feelings of motivation in women (not sexual motivation, but motivation in its general concept, which is actually a function of testosterone). Estrogen is truthfully not a female hormone but instead a hormone of growth which causes cells to take up more water so that they can undergo the process of mitosis (cellular division), and having more estrogen causes a human body to be softer and store more fat and enables reproductive processes such as what occur in the ovaries and uterus to promote fertilization and growth of a fetus, as well as healing of injury and regeneration of tissue. Because of its growth effects estrogen is also a major factor in cancer and tumor growth, and the body of a woman is actually protected from the inappropriate growth effects of estrogen in adult tissue by the hormone progesterone, which is in fact more important for achieving femininity than estrogen, the misunderstanding of which in the pharmaceutical and medical industries is a product of corporate profiteering from estrogen products, since natural progesterone can actually be synthesized cheaply. This misunderstanding causes all female hormone therapy, both cis and trans, to be ineffective and sometimes be accompanied by unacceptable risks of cancer since estrogen is a hormone of growth.
For this same reason gender transition from female to male is often more successful than male to female because there is far less misunderstanding about male hormones, though some does still exist. Testosterone is anabolic and typically helps build muscle and promotes an increased metabolic rate, but most people do not know that estrogen in the body is actually made from testosterone through a process called aromatization in which aromatase enzymes convert androgens to estrogens. This is why women who present with conditions like polycystic ovary syndrome (PCOS) or endometriosis can present with masculinization such as a mustache or thicker muscles, because the condition inhibits the enzymes which produce estrogen from testosterone this causes an increase in testosterone and thus masculinization of the female body. In an unhealthy male body (i.e. slow metabolism) testosterone similarly can and does aromatize to estrogen which causes development of breasts, extra body fat, and other feminization in males. Ironically this aromatization occurs primarily in the testicles due to colonization with opportunistic pathogens as discussed in F*ck Portion Control, especially sexually transmitted parasites like Trichomonas which alter our endocrine function to produce more estrogen for their reproductive needs. In aged or ill cisgender men and in bodybuilders who use excess steroids the supplementation of extra testosterone results in greater aromatization of testosterone to estrogen and the body downregulates its own production of testosterone by shrinking the testicles, and since estrogen is a hormone of growth this also leads to undesirable growth effects of the steroids such as enlargement of the head, navel, and organ diseases. Transgender men do not possess testicles in which testosterone can aromatize so they have less risk of aromatization to estrogen, but since estrogen is produced from testosterone even in female anatomy such as the ovaries the use of aromatase inhibitors such as those used in cancer therapy can be used by transgender men to get natural, endogenously made testosterone from their own bodies which can make the transition process easier and require less testosterone injection. Because estrogen is also a hormone of healing, however, this could interrupt recovery from injury, workouts, or general regeneration during sleep and should not be used in high doses and under care of a medical professional to monitor health and progress.
Another misunderstanding in transgender male care is that regular testosterone is not the primary form of testosterone which promotes maleness, but instead the active form of testosterone is called dihydrotestosterone (DHT) which also does not aromatize into estrogen and is more responsible for the specific androgenic features of men such as hairy, larger forearms and facial hair. DHT is mistakenly thought to promote male-pattern baldness, which is incorrect as discussed in the chapter on hair loss in F*ck Portion Control, so many doctors do not even recommend DHT in male gender affirming medical care when in fact it would be more useful than simply using testosterone alone and will more actively and rapidly promote maleness. Additionally, the hormone dehydroepiandrosterone (DHEA) is a weak androgen which supports other male features and is also available as a supplement (in most countries) without prescription and can be taken in low dose daily to further support male gender characteristics.
Hormones needed for effeminate physiology, estrogen and progesterone, are in their use and application for both transgender women and cis-gender hormone replacement therapy generally flipped by common medical treatment when it comes to the importance of either, since estrogen is primarily a hormone of growth. When estrogen is given without progesterone it induces problems like weight gain, sluggish metabolism, thickening skin and body mass, hair loss or thinning, rapid skin aging, and in the long term even breast cancer because estrogen slows down the metabolic rate of cells (to prevent damage to cells when undergoing mitosis) which then also disrupts metabolic functions required to maintain youthful, healthful characteristics. When more progesterone is used than estrogen this instead results in a more youthful and healthy metabolism, healthy skin, hair, etc., because progesterone not only directly supports functions like thyroid and sleep but is also slightly antiparasitic which also protects against the harmful effects of parasitism (which is more widespread than most people appreciate). Young men have as much progesterone as young women not on their cycle, but progesterone in high doses also antagonizes androgens and it is progesterone, not estrogen, which can more strongly suppress male characteristics and promote those of the feminine. While some estrogen is needed to grow breasts, progesterone specifically amplifies and promotes breast enlargement, and small breasts (clinically, not aesthetically) are an indicator of low progesterone production which frequently arises from harmful dieting habits since both carbohydrates and fats are required to produce hormones endogenously and keep a high, healthy metabolic rate. Harmful effects of progestins come from their synthetic forms and it is far better to take natural progesterone such as derived from wild yam (wild yam is not the same as progesterone, which is instead enzymatically treated to become progesterone).
Natural progesterone is available without a prescription, and can be taken safely in high doses even in those who cannot afford to do medically assisted transitioning, and typically doesn’t cost very much compared to pharmaceuticals, and will effectively and strongly diminish maleness in those who use it, even if the male gonads are still present while also promoting general metabolic wellness (it will actually shrink the penis and testicles if used in higher doses for long periods of time). The most prominent “side-effect” of progesterone is that it is also the hormone of empathy, so taking high doses will make a person highly sensitive and emotional (this is what women experience during a menstrual cycle, and is a natural effect of progesterone), and can and is often mistaken for increased depression or sadness if you have those feelings but in reality an intensification of any feelings you may have and should be expected from using progesterone. Because progesterone is generally healthful for the body, and also involved in protecting men’s health, albeit in smaller amounts, it persists in the body for a long period of time (one dose can last for several days), so once supplementation is begun it is easy to maintain effective levels with lower doses so long as they are consistent. Progesterone can be taken orally or mixed with a very small amount of good fat such as coconut oil or olive oil and applied to skin or mucosal tissues and will absorb very rapidly. Progesterone in very high can sometimes cause nausea because it also softens the internal organs (for anticipation of pregnancy) and if that occurs doses are much too high and should be reduced. Many natural progesterone products are also formulated with vitamin E, and excess vitamin E can cause hemorrhage, so other vitamin E supplements should not be taken while using such a product.
Some supplemental products like Saw Palmetto which claim to promote things like prostate and hormone health in men are actually testosterone antagonists (meaning they actually promote estrogen, because testosterone is wrongly thought to promote prostate cancer but which is instead caused by colonization of the prostate with Trichomonas parasites that aromatize testosterone to estrogen as discussed in FPC). Prescription hair loss medications also often block DHT to reduce the most male characteristics, softening muscles and reducing body hair and affecting the voice, and while medicines like finasteride block DHT and could be used for transgender women it also produces side effects such as depression and might be more harmful in the long run than simply using high progesterone. Pine Pollen is one of the few nutritional sources of natural androgens, though it is not strong enough to replace prescription testosterone, and since DHEA is widely available as a supplement it’s likely to be more effective. Other herbs and supplements are often promoted as doing the opposite of what they do in reality, and are often not at all harmless, and much caution should be weighed when evaluating claims of such products, especially ones which are promoted as treating depression like 5-HTP and melatonin which in reality actively lower the metabolic rate and promote depression, and melatonin actively suppresses sex hormones altogether and supplementation of melatonin can result in anhedonia and worsening of sleep.
It is very common today for transgender women to take anti-hormones like Spironolactone which inhibits the effects of androgens on the body. But these are also diuretics and are very dangerous to take and can cause dramatic reductions in blood volume and risk heart attack due to excessive potassium retention and more viscous blood. They also cause the body to revert to a somewhat prepubescent state rather than one of feminine characteristics like breasts, hips, and extra subcutaneous fat (which promotes softer skin), so transgender women using these diuretics appear more as large children rather than fully matured women, and its use while well intentioned has been greatly misguided. All human bodies have breasts, including men, which is why men’s breasts enlarge when they start to age or abuse steroids or experience metabolic illness, and the highest cohort of gender confirmation surgery in the world are young men presenting with gynecomastia (enlargement of breast tissue in males) due to poor diets and insufficient exposure to sunlight as discussed in F*ck Portion Control, but this also means that transgender women can and do grow their own breasts when receiving proper hormone therapy which does not include anti-hormone medications like Spironolactone as the body needs to produce its own hormones in order to be healthy and naturally developed. As discussed earlier, aromatization of testosterone can and does occur in a male body, so in transgender women the use of progesterone and estrogen will be sufficient to inhibit androgens since estrogen causes testicles to downregulate their production of testosterone since the male body is designed to interpret estrogen as an indicator of aromatization to which it adapts through reduced production of testosterone. In the future, the development of an aromatase agonist with high specificity (a medication that has aromatase function or promotes an increase in aromatase) could also be effective and reduce the need for supplemental estrogen by causing more to be made in the body endogenously from testosterone the same way that occurs in a female body.
Lastly, physical scarring from surgical care is often an issue in the transition process. Some people rightly love their scars as they are a sign of triumph and a badge of their struggle and courage, and there is nothing wrong with physical scars even if they may make us feel insecure, which is okay. But scarring can also be mitigated by keeping fresh wounds moistened with coconut oil and tightly covered with plastic wrap the same way a fresh tattoo is treated by an air-tight covering to prevent scarring. Coconut oil is high in saturated fats which in turn keeps skin moisturized and pliable to facilitate stem cell migration to the injury site and regenerate scarless tissue, and slightly antibiotic to keep out bacteria which inhibit the healing process. An air-tight wrap holds CO2 against the skin and CO2 elevation increases rate of healing—on that same note, though post-surgery may also be painful, NSAIDS like tylenol and ibuprofen actually slow down or even outright impair tissue regeneration because they too powerfully inhibit inflammation which is needed for tissue to actually regenerate, so try to get off those as quickly as possible (never take them if you absolutely do not need to). Aspirin actually improves healing and though it is not as powerful a pain inhibitor will make regeneration faster and thus the duration of post-surgery pain far, far less (always follow your doctor’s advice).
This world can be cruel, but there is much beauty in it too—for example, you. As a gay man who grew up in a homophobic and conservative community I long believed God didn’t love me and that I was defective because of the way I was. I eventually learned that my prayers were always being answered, they just weren’t the answer my family wanted. The story of my struggle with depression in F*ck Portion Control and how I overcame it will help empower you to do the same, and the trauma therapies in The Perfect Child can help shed the burdens of unresolved pain and trauma associated with our struggles, to emerge the stronger, wiser, and more compassionate—compassionate not for other people, though that will come too, but towards yourself, and if you are interested in spirituality go read Under A Libra God to learn more about God, how the Universe works, and useful astrology.
Many of us in the LGBTQI+ community also suffer from alcoholism and addiction due to the stress of growing up in harmful communities, but this too can be addressed easily and accessibly as discussed in this excerpt from my book The Cure For Alcoholism and Addiction. Reliance on substances does not need to control your life, and can be relieved through some simple adjustments to your diet and environment which resolve the underlying neurological problems that cause it.